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Provider Enrollment and Management System (PEMS)

Last updated on 8/1/2022

A Step-by-Step Guide

These pages will guide you through the process of enrolling as a provider using TMHP's Provider Enrollment and Management System (PEMS) tool. Additional helpful resources are available on the Enrollment Help page and the TMHP YouTube channel.

To begin, please select the type of application you will be completing. The Application Type you select will determine how TMHP processes your application.

Select an option below for a description of each application type:

PEMS New Enrollment is when a National Provider Identifier (NPI) or Atypical Provider Identifier (API) that has never been enrolled in Texas Medicaid or other state health-care programs, that does not have an existing enrollment record in PEMS, or a Change of Ownership (CHOW) has occurred for an existing provider enrolled in Texas Medicaid or other state health-care programs. To continue with this option, click here.

PEMS Existing Enrollment is used to add a new practice location or add additional programs to an existing National Provider Identifier (NPI) enrollment record. In addition, the provider will use the existing enrollment option when disenrolling from a program. Providers cannot submit an existing enrollment application if they are currently within their revalidation period. To continue with this option, click here.

PEMS Revalidation is when a provider submits a revalidation application for a Provider/National Provider Identifier (NPI) that has an existing enrollment record in PEMS prior to the end of their enrollment period without an enrollment gap. Providers should submit their Revalidation applications at least 120 days before the end of their enrollment period so that the Revalidation process can be completed before the enrollment period ends. Providers who do not submit the Revalidation application by the Revalidation Due Date must submit a Reenrollment application. To continue with this option, click here.

PEMS Reenrollment is when a provider submits an enrollment application for a Provider/National Provider Identifier (NPI) that has an existing enrollment record in PEMS that has been dis-enrolled, terminated, excluded, or otherwise removed as a provider. The provider must submit a Reenrollment application if they did not submit a Revalidation application by Revalidation Due Date or previously requested date for disenrollment or removal from the program. The provider will receive the same risk category assignment and go through the same provider screening activities as a newly enrolling provider. To continue with this option, click here.

PEMS Maintenance allows providers to maintain the current enrollment record updating demographics and provider records
Select this option if you require updates to your existing NPI-based enrollment record. Within the Edit Enrollment screen, the available options for Request Type or Request Actions will be based on the Enrollment Status of your enrollment record as well as the status of any maintenance request that is being processed. To continue with this option, click here.